Conventional treatments effectively improve symptoms of GERD. Is aloe vera a reasonable natural treatment option?
Panahi Y, Khedmat H, Valizadegan G, Mohtashami R, Sahebkar A. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med. 2015;35(6):632-636.
To assess the efficacy of aloe vera in reducing symptoms of gastroesophageal reflux disease (GERD), and to compare it with the efficacy of omeprazole, a proton pump inhibitor (PPI), and ranitidine, a histamine 2 receptor antagonist (H2RA)
Randomized, open-label, positive-controlled trial
Participants received either 10 ml of aloe vera syrup per day (standardized to 5.0 mg polysaccharide per mL), an omeprazole capsule (20 mg per day), or ranitidine tablets (150 mg in the morning and 150 mg before sleep at night) for a period of 4 weeks.
Participants were between the ages of 18 and 65, diagnosed with GERD, and referred for endoscopy. A total of 79 participants were enrolled in the study; however, 4 participants dropped out due to adverse events (2 in the ranitidine group and 2 in the omeprazole group). Exclusion criteria included pregnancy, breastfeeding, and presence of hematemesis, odynophagia, treatment-resistance GERD, other gastrointestinal disorders, hepatic disease, hematological diseases, use of muscle relaxant medications, or history of sensitivity to aloe vera.
Study Parameters & Primary Outcomes
A modified Reflux Disease Questionnaire consisting of 8 key symptoms of GERD (heartburn, food regurgitation, flatulence, belching, dysphagia, nausea, vomiting, and acid regurgitation) was used to evaluate the efficacy of each treatment. These symptoms were assessed at weeks 2 and 4 of the trial, and then compared among treatment groups.
The group who received aloe vera syrup experienced reduced frequency of all assessed GERD symptoms at weeks 2 and 4 compared to baseline, without any intolerable effects. However, when compared to both conventional treatment groups, aloe vera syrup was less effective at reducing frequency of heartburn, flatulence, and belching. While perhaps less effective for those specific symptoms, aloe vera syrup was found to be a safe, effective, and well-tolerated treatment option.
The results of this study show that aloe vera syrup is a safe, effective, and well-tolerated treatment for common symptoms of GERD.
Both groups treated with conventional medication (omeprazole and ranitidine) experienced a more significant reduction in the frequency of all assessed GERD symptoms at both assessment intervals when compared to baseline, and compared to the aloe vera. However, each group in the conventional arm had 2 patients drop out due to adverse effects, while the aloe vera arm had no dropouts.
The results of this study show that aloe vera syrup is a safe, effective, and well-tolerated treatment for common symptoms of GERD. While symptomology was more reliably improved with acid-blocking drugs, this appeared to have a greater risk of intolerable side effects as well.
Other studies support the use of aloe vera in the treatment of GERD. A recent study published in JAMA suggests that the pathogenesis of reflux esophagitis may be due to inflammation rather than chemical injury caused by gastric acid.1 In 2007, Yoshida published a study also implicating inflammation and oxidative stress in GERD.2 Aloe vera has proven anti-inflammatory and antioxidant properties,3 so these actions may contribute to its benefits for symptoms of GERD. A study published in 2012 showed that Faringel, an antacid supplement containing aloe vera gel, reduced heartburn in patients with erosive and non-erosive esophagitis.4 Given its anti-inflammatory effects, aloe vera may be beneficial for long-term complications associated with GERD, such as Barrett's esophagus. However, there are no clinical trials published to date on that topic. Numerous animal and human studies have demonstrated positive effects of aloe vera in other gastrointestinal conditions such as Helicobacter pylori infection,5-6 irritable bowel syndrome,7 ulcerative colitis,8-9 and peptic ulcer.10-11
Although aloe vera syrup was overall less effective in reducing the assessed GERD symptoms compared to both conventional treatment options, these types of medications have numerous adverse effects. Recent studies have linked use of PPIs with an increased risk of hip fracture,12-13 dementia,14 enteric infection and overgrowth,15 myocardial infarction and overall cardiovascular mortality,16 kidney disease,17 cellular aging,18 and others. Despite having a milder adverse effects profile than PPIs, H2RAs have been linked with an increased risk of bacterial overgrowth,19 rebound hypersecretion,20 and vitamin B12 deficiency.21 Histamine 2 receptor antagonists, especially cimetidine, also inhibit the liver enzyme cytochrome P450 which can significantly impact metabolism of numerous drugs.22
In addition to aloe vera, many other natural therapies have been shown to have positive effects on GERD, including diet and lifestyle modifications,23-26 d-limonene,27 melatonin,28 and Iberogast.29 In addition, numerous articles reviewing natural treatments for GERD are available.30-32